Marcuccilli, Charles J

Marcuccilli, Charles J is an individual health care provider with primary practice located at 180 Harvester Dr Suite 110, Burr Ridge IL 60527-7594. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology. Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology is his primary health care specialty. Marcuccilli, Charles J can be contacted via phone (773) 702-1150.

Contact Information

Primary practice address
180 Harvester Dr Suite 110 Burr Ridge IL 60527-7594
Phone: (773) 702-1150
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 48736 Wisconsin
Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology 2084N0402X 036102274 Illinois

Profile Details

NPI number 1801849559
LBN Legal business name Marcuccilli, Charles J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2006
Last updated Nov 8th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801849559 NPPES
Wisconsin MEDICAID 34818000

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